Sunteți pe pagina 1din 8

Nutrition and School Performance

Spring 2003
4
and necessary for the learning ability of children.6
These benefits have been identified by short-term
studies (missing breakfast once) and long-term
studies (missing breakfast consistently).4
The results of a just-published American study,
Diet, Breakfast and Academic Performance in
Children, concluded that participation in
breakfast programs improved daily nutrient
intake and this improvement was associated with
significant increases in scholastic performance.12
Children at nutritional risk, that is, those who
received less than 50% of the recommended
dietary allowances (RDA) prior to the introduction
of a universal breakfast program, had significantly
poorer grades than children not at nutritional
risk. Improvements in math grades were seen in
the breakfast program participants but not in
those who remained at nutritional risk.12
In Canada , no formal assessment has been
conducted to indicate the food and nutritional
needs of students. Nevertheless, the National
Child Hunger Survey in 1997 reported that
Canadians believe that approximately 42% of
children are not having adequate breakfasts
before going to school.4,6,7 This is mirrored by
research from Toronto Public Health,
Scarborough Office, that found 7 to 10% of
elementary school students eat no breakfast and
40% eat an inadequate breakfast.5 NWT statistics
indicate 33% of children come to school hungry
and 29.6% skip breakfast or lunch.3 As well, the
NWT Youth in Transition Study of May 2002
reported that significant numbers of youth,
particularly Dene and Inuit, are often missing
two food groups from their diets, milk and milk
products and fruits and vegetables.13
What is a Healthy Breakfast?
Clearly, breakfast is the most important meal of
the day. A summary of school and community
nutrition programs completed by the Breakfast
For Learning group indicates that poor eating
habits are a growing concern across the country.5
There are three components to a healthy breakfast:
1. Foods are eaten from at least three of the four
food groups,
2. Foods are well balanced to sustain a child’s
energy throughout the morning, and
3. Foods offer at least 25% of the day’s calories
and essential nutrients.2
Nutrients of particular importance to scholastic
achievement and development are carbohydrates,
protein, iron and calcium.5 Carbohydrates, the
main fuel for the body, break down to glucose
that supplies energy to the brain. Diets deficient
in protein and iron are highly correlated with
poor intellectual development in children.7 Iron,
an essential nutrient in cognitive development
and learning ability, and calcium essential for the
development of healthy teeth and bones, when
missed at breakfast, are not readily obtained in
subsequent meals and snacks throughout the day.5
Eating breakfast satisfies hunger and helps to
maintain a steady blood sugar level. This is key
to remaining energetic and able to concentrate.
It is also a sign that one’s diet is good overall.5
Therefore, missing the morning meal is indicative
of a larger, unhealthy eating pattern.
Behavioural and Psychosocial Benefits
of School Nutrition Programs
A balanced breakfast offers many other benefits
to school-aged children and subsequently to
teachers, the classroom environment, and
the school.
• Teachers, parents and students state that,
with breakfast, there are fewer classroom
disruptions and discipline referrals, and
there is improved attendance and class
participation.4,6
• A 1996 evaluation of the British Columbia
School Meal Program concluded from
interviews with parents, teachers and
administrators that students who eat a
nutritious meal concentrate better, attend
school more regularly, are less aggressive,
and show improved behaviour overall.2
• Hungry children are more likely to have low
energy, be late or absent, be more apathetic,
disinterested, irritable or hyperactive, have
more trouble concentrating, and have lower
self-esteem or poorer social skills than
their peers.5
“When a child’s stomach
is empty, everything else
is secondary. Before
developing a thirst for
knowledge and a hunger
for learning, one must
satisfy the body’s thirst
and hunger. This is a
challenge faced by
our society.”
Romeo LeBlanc,
former Governor
General of Canada .
EPINORTH
5
• The American study, Diet, Breakfast and
Academic Performance in Children, found that
participation in a breakfast program improved
students’ psychosocial functioning and
attendance.8
• In the NWT, the Healthy Living School Project,
Phase III survey respondents indicated that
with food programs there was a 35% increase
in students’ ability to learn and concentrate
on their schoolwork and a 17.5% improvement
in overall school performance.3
Why do Children go to School Hungry?
There are two main barriers to children accessing
a meal before school starts:
1. Poverty. The increased incidence of child
poverty in Canada from 1989-1997 is a key factor
contributing to the development of school
feeding programs.5 One in five children still live
in poverty. From 1989 to 1997, the rate of
children living in poverty increased from 15% to
20%. That means that the number of poor
children in Canada increased from 936,000 to
1,397,000.6 Children living in poverty are
particularly vulnerable to arriving at school
hungry or undernourished.
2. Changing Lifestyles. There is also strong
evidence that Canadian children from all income
brackets go to school without having had a
morning meal.3,5 These days, many adult caregivers/
parents work outside the home. This gives
the family less time to prepare and share breakfast
together, or, if parents leave home before their
children do, to assure that a breakfast is eaten.5
Other reasons given for breakfast being skipped
are: extra-curricular activities before school,
norms created by parents and caregivers who do
not eat breakfast, long bus rides, no time in the
morning, not hungry before school, and desire to
lose weight.2
Social and Economic Costs and Benefits
Socio-economic status, education level, and
healthy child development are just three of the
twelve determinants of health that could be
addressed by giving more attention to the proper
growth and development of children in their
formative years. The costs in interventions that
would improve nutritional health would be
modest compared to health related costs
associated with poor nutrition or lack of learning
potential and future contributions to society.
In the NWT, timely direction on where to focus
efforts in improving school nutrition programs is
being given by the Healthy Living School Project,
Phase III.3 This project is a collaborative effort of
the Northern Nutrition Association and the
Canadian Public Health Association (Northwest
Territories/Nunavut Branch), and funded through
Health Canada and the NWT Department of
Health and Social Services. A total of 46 out of a
possible 52 schools, representing 32 communities
in the NWT, were surveyed on school nutrition
programs and food security. The top five
suggestions from survey respondents that could
form the basis for further development of schoolbased
nutrition programs in the NWT include:3
• offer parents nutrition education,
• increase funding to school nutrition
programs,
• teach children about nutrition,
• update curricula and resources, and
• involve the community in programs.
These responses indicate that the family and
community must create and maintain
worthwhile programs, that funding for nutrition
programs is an issue and that it is not enough to
simply feed children. Nutrition education backed
by strong curricula and appropriate resources are
also necessary.
Next Steps
Although it is the parent’s primary role and
responsibility to feed their child and be the
guardians of their healthy growth and
development, it is also apparent that lack of
money and time prevent many parents from
doing so. Our challenge is to help children in the
NWT going to school, or being at school, undernourished
and unable to learn. Many studies
have indicated that not only a child’s education
but also their social learning and interaction can
be greatly compromised when they have not had
a balanced meal to start the day.
Continued

http://www.hlthss.gov.nt.ca/content/Publications/Newsletters/epinorth.asp

This supplement to the Food and Nutrition Bulletin


includes a selection of papers presented at an international
meeting held from February 18–20, 2004,
at the University of California , Los Angeles , titled
“School Children: Health and Nutrition.” The research
data presented and the questions that arose about the
effectiveness and efficiency of interventions presently
available (e.g., nutrition education, school feeding,
deworming) are at the forefront of this field of work.
Although health and nutrition interventions in schools
have a long history, the recognition of their potential
educational benefits to schoolchildren in low-income
countries has never been stronger than it is today [1].
The research work of many investigators, the leadership
and funding of various international agencies,
the motivation and actions of several countries, and
the advocacy of interested parties have unleashed an
unparalleled movement to improve the well-being of
schoolchildren and their learning of the competencies
required by a modern economy.
Contemporary theories and research in developmental
science have shed new light on old and new
data on the developmental effects of poverty and
malnutrition as well as on the impact of health and
nutrition interventions at different periods of children’s
development. These advances explain, in my
view, part of the recent growth in the assessment and
implementation of health and nutrition policies and
programs targeted toward schoolchildren. While there
is no consensus, there is wide recognition today that
the psychobiologic development of children is plastic
and it follows a course that uninterruptedly depends
on the interplay between the changing organism and
its changing environment [1–5]. The development of a
child is sensitive to the influences of adverse biophysical
and social-cultural factors and the long-term outcomes
will generally depend on the life course events [6].
Under conditions in which populations generally live
(e.g., endemic poverty), these factors do not operate as
independent agents that cause particular quantifiable
changes in one specific developmental domain. Rather,
the effects of such factors (e.g., iron deficiency anemia)
are, or can be, moderated by developmental stage (e.g.,
early infancy), health (e.g., infection), ecology (e.g.,
altitude above sea level), and sociocultural (e.g., quality
of caretaking) and economic conditions (e.g., level
of poverty), and together they influence the course of
child development [7]. The strongest influences are
generally observed during infancy and the early years
of life [8–10]. Further, the effects detected in one particular
domain (e.g., cognition) are rarely isolated from
other domains (e.g., motor, socio-emotional) because
one of the characteristics of development is precisely
the reciprocal influences among subsystems within the
organism [11, 12].
In agreement with the above considerations, young
children could follow two different developmental
courses in populations where poverty and malnutrition
are typical. In one case, the psychobiologic development
of children will be continuously at risk whenever
poverty, illness, and malnutrition characterize their life
course and their effects join. Recall that it is the number
and relationships of socioeconomic and biologic stress
factors and their cumulative effects that determine the
developmental course rather than any one particular
factor [11–15]. In the other case, with some important
exceptions (e.g., cretinism, extreme deprivation), there
will be a significant shift of the developmental course
whenever there is a lasting improvement in their social
and economic status as well as in health and nutrition
[16]. This shift allows the reorientation of the developmental
course toward a comparative better level of
well-being.
There are no studies, to my knowledge, that have followed
children from birth to adulthood and have measured
the independent and cumulative effects of poverty,
Introduction
Ernesto Pollitt is Professor Emeritus, University of California ,
Davis, California.
Please direct correspondence to the author: Ernesto Pollitt,
Malecon Grau 260, Chorrillos , Lima 9, Peru ; e-mail:
epollitt@ucdavis.edu.
Mention of the names of firms and commercial products
does not imply endorsement by the United Nations University.
Ernesto Pollitt
S132
poor health, and malnutrition on intellectual development
and education through the generally recognized
developmental periods, across a variety of eco-cultural
settings. Nonetheless, several studies in developed and
developing countries have looked at selective aspects of
the overall perspective presented above. These studies,
which can be characterized as partial approaches to
the overall picture, have focused on different degrees
of poverty, poor health, and malnutrition; have looked
at different developmental domains and periods; have
used different definitions of intellectual development
and widely different methodologic approaches, and
have been conducted in a myriad of widely different
eco-cultural contexts. This state of affairs in a specific
area of research parallels the vast difficulties faced by
social and behavioral researchers to develop universally
valid, widely accepted conceptual and methodologic
approaches to study complex problems in different
cultures. However, owing to the social relevance of
the issue at hand, it is important to scrutinize findings
from available research that are well established.
With careful consideration for basic issues of external
validity [17], the generalizations presented in the next
paragraph regarding the cumulative effects of poverty
and malnutrition are efforts in this direction.
In the different ecologic settings inhabited by economically
impoverished families in the developing
world, 2- to 3-year-old children who are ill and
malnourished carry an acquired initial disadvantage,
compared with children of the same age of middle-class
parents in the urban centers, for the later learning of
the competencies taught in formal schools [18]. This
initial reduction in the chances for success to deal
effectively with problems considered important in
school settings will increase up to the time when they
enter primary school even though their attendance in
a preschool might assuage somewhat the magnitude of
the disadvantage [17]. Even larger differences will set in
during primary schooling. The disadvantaged children
will continue to experience the cumulative adverse
effects of their poor socioeconomic background [19]
and, in addition, the schools they will attend will be of
a lesser educational quality than the schools available to
children who are well off economically [20, 21]. Such a
difference will endure if, before or at the end of primary
school, the disadvantaged children drop out of school.
In the absence of major social and economic changes,
this one event generally prevents the acquisition of
the competencies presently required by fast changing
societies and modern technology [22]. In this sense,
schooling is a unique window of opportunity. Consider,
however, that this view is heavily influenced by the
notion that there are certain competencies, valued in
Westernized societies, that are, or should be, taught in
schools so that the students will be eventually competitive
in that kind of context [23].
Studies conducted in a span of about 40 years have
tested the functional effects of improving the health
and nutrition of children in early life and during
the school period [24–27]. A body of information is
now available that might not be complete to meet the
stringent criteria of established knowledge but is sufficiently
strong to allow for responsible interventions
and policymaking [28]. Supplementary feeding during
infancy and the preschool period led to significant
improvements in performance in school achievement
tests administered in adolescence [29]. Within this
same study, a subsequent follow-up of the women
when they were young adults showed a significant
effect on similar indicators of educational attainment
[30]. Of critical importance to education are the data
from recent studies, which show that the cognitive and
school competence of schoolchildren will benefit from
health and nutrition interventions during school even
though they experienced multiple and continuous
biologic- and socioeconomic-induced stress in early
life [25, 27]. Qualitative and quantitative improvement
of the diet of rural schoolchildren led to significant
improvements in their educational performance and
social behavior [31, 32]. True, the health/nutrition
intervention in schools is not likely to compensate for
the educational loss over years of disadvantage; nevertheless,
school competence will improve. In some cases,
depending on the intervention, the effects will probably
be restricted to improvement of school attendance [33].
Nonetheless, the benefits of school programs are such
that the educational system should consider health/
nutrition interventions as one way of improving the
educational competency of schoolchildren.
There is need for further understanding of the
cultural and economic influences in the variability of
the responses of parents and teachers to some of the
effects produced by nutrition and health interventions.
In some situations, these responses will moderate the
effects of the interventions and such an understanding
helps wise policy decisions. For example, early supplementary
feeding improves physical growth in populations
where poverty and malnutrition are endemic
[34]. While in some communities taller children were
less likely to enroll late in school and drop out early
[35], in other communities, comparatively taller children
were more likely to drop out from primary school
to help their parents at work [36]. This latter case suggests
that the parents attributed greater value to the
contribution of the child to the family’s economy than
to the educational benefits from elementary schooling
[23]. In these latter communities, other indicators of
nutrition status (e.g., energy intake) among adult men
were related to work productivity [37].
One concern is that studies on health/nutrition
interventions on schoolchildren are often guided by
definitions and values of Westernized societies given
E. Pollitt
S133
to health/nutrition (e.g., stature, activity) [38] and
educational (e.g., competencies) outcomes [23]. For
example, researchers usually value the increments in
activity that follow the administration of supplementary
micronutrients [39, 40] given to poorly nourished
children. However, such increment in activity among
schoolchildren might explain why iron supplements
given to schoolchildren in Zanzibar were associated
with an increment in the repetition of grades from
first-to-second-to-third grade [41]. Mothers in Tanzania
[42] and teachers in other sub-Saharan communities
[43] value students with a receptive disposition and
listen quietly without interrupting the transmission
of information. In that context, teachers might have a
low tolerance for increments in physical activity. How
should the educational system proceed?
The large numbers of poor children in the developing
countries, the limitations of the funding for the social
sector, the problems of organization and administration
of large-scale health and nutrition interventions,
and the ideologic differences associated with any socialpolitical
problem will challenge the implementation
and maintenance of health and nutrition interventions.
However, by any measure or standard, the progress
made during the last 5 years in the implementation of
school health and nutrition policies and programs and
in the understanding of the effects of these programs
has been remarkable.
www.iuns.org/features/task force report_school children.pdf

S-ar putea să vă placă și